As public and private payors, policymakers and practices seek to determine whether investment in the medical home model can improve the quality and efficiency of health care in the United States, the identification of a valid means for measuring whether a particular pediatric physician practice has the capacity to serve as a medical home is very important. Several instruments have been developed or adapted to measure the features that contribute to a medical home. One of these, the Medical Home Index (MHI), was created specifically for pediatric practices, and has now been validated and used in over 100 practices. Another important instrument, the National Committee for Quality Assurance's (NCQA) Physician Practice Connections-Patient Centered Medical Home (PPC-PCMH)", is being widely used in medical home demonstrations across the nation and has been made available on-line to primary care practices so that they may self-assess their readiness for NCQA medical home recognition. Although the practice features measured by these instruments are widely thought to contribute to improved health outcomes, only one study has used a validated instrument to test the degree to which a medical home is associated with child health outcomes. The long-term goal of this proposal is to help practices, payers and policymakers identify which features of pediatric primary care medical home practices optimize outcomes for children so that they may make targeted investment and intervention decisions. The specific aim is to test the association of the Medical Home Index and a Primary Care Medical Home self-assessment tool with child health outcomes by: (1) testing the association of the MHI and a PCMH self-assessment tool with each other;(2) testing the association of each domain within these tools with child health outcomes;(3) describing practice characteristics associated with higher and lower instrument scores;and (4) testing the independent effect of contextual factors on child health outcomes. The hypotheses are that practices scoring higher on the instruments will have better child health outcomes in terms of the AHRQ Core Child Health Care Quality Measures and AHRQ Pediatric Quality Indicators;practices scoring high on one instrument and low on the other will have good (intermediate) child health outcomes, but differ as to which instrument they score higher on by relevant contextual factors such as urbanicity/rurality, payer source, type of practice and use of electronic data;and practices scoring poorly on both instruments will have the worst child health outcomes. Three data sources will be used for this study - a registry of pediatricians, survey data, and claims data from the Indiana Patient Care Network - to test our hypotheses. Measured outcomes are from the Pediatric Quality Indicators and Core Child Health Measures. The proposed research is significant in that the realization of our objectives will enable entities with limited resources to prioritize their investments and tailor interventions for effective health care transformation. This project speaks directly to the mission of AHRQ, which is to improve the quality, efficiency, and effectiveness of health care for all Americans. PUBLIC HEALTH RELEVANCE: The proposed research is relevant to public health because it will help practices, payers and policymakers identify which features of pediatric primary care medical home practices optimize outcomes for children so that they may make targeted investment and intervention decisions.